Quality of Life Research

, Volume 25, Issue 9, pp 2161–2178 | Cite as

The health-related quality of life of Indigenous populations: a global systematic review

  • Blake AngellEmail author
  • Janani Muhunthan
  • Anne-Marie Eades
  • Joan Cunningham
  • Gail Garvey
  • Alan Cass
  • Kirsten Howard
  • Julie Ratcliffe
  • Sandra Eades
  • Stephen Jan



Indigenous conceptions of health have been shown to differ from that of their non-Indigenous counterparts. As a result, there remains uncertainty over the appropriateness and value of using existing health-related quality-of-life (HRQoL) instruments in Indigenous communities. The objective of this review was to identify studies that either measure the HRQoL of an Indigenous population or validated a measure used to elicit the HRQoL in an Indigenous population.


A systematic review of the published literature was conducted to (1) investigate the extent to which HRQoL instruments are used in Indigenous populations; (2) to identify which instruments have been validated in which populations; and (3) to identify which instruments have been tailored for use with Indigenous populations.


Forty-one studies were included in the review. Only three of the 41 studies utilised Indigenous-specific instruments. The remainder (38 studies) utilised generic population or disease-specific instruments. Four studies found specific HRQoL instruments to be valid in these populations and 32 estimated the HRQoL of an Indigenous population. The limited examples of Indigenous-specific instruments highlighted the potential importance to the HRQoL of these populations of domains that lie outside of traditional measures including social and community domains as well as domains relating to culture, diet and land use on top of more traditional HRQoL domains.


Ensuring that the HRQoL of Indigenous populations is being appropriately measured is vital to prioritising available resources to the most effective interventions. HRQoL instruments present an opportunity to directly elicit and incorporate Indigenous preferences and conceptions of health into these decisions. Further work is required in the field to ensure that this potential is realised.


Health-related quality of life Systematic review Indigenous populations Quality-of-life instruments 


  1. 1.
    Gracey, M., & King, M. (2009). Indigenous health part 1: Determinants and disease patterns. The Lancet, 374(9683), 65–75.CrossRefGoogle Scholar
  2. 2.
    World Health Organisation (2014). Indigenous populations. 12 November 2014.
  3. 3.
    Mooney, G. H. (2009). Challenging health economics (pp. 1–250). Oxford: Oxford University Press.CrossRefGoogle Scholar
  4. 4.
    Kunitz, S. J. (2007). The health of populations: General theories and particular realities. New York: Oxford University Press.Google Scholar
  5. 5.
    Maher, E., et al. (2005). Health-related quality of life of overweight and obese children. JAMA, 293(1), 70–76.CrossRefPubMedGoogle Scholar
  6. 6.
    Chenhall, R. D., et al. (2010). Individual quality of life among at risk indigenous youth in Australia. Applied Research in Quality of Life, 5(3), 171–183.CrossRefGoogle Scholar
  7. 7.
    Ring, L., et al. (2007). Individual quality of life: Can it be accounted for by psychological or subjective well-being? Social Indicators Research, 82(3), 443–461.CrossRefGoogle Scholar
  8. 8.
    Nagel, T., Hinton, R., & Griffin, C. (2012). Yarning about Indigenous mental health: Translation of a recovery paradigm to practice. Advances in Mental Health, 10(3), 216–223.CrossRefGoogle Scholar
  9. 9.
    Carson, B. (2007). Social determinants of indigenous health. Crows Nest, NSW: Allen & Unwin.Google Scholar
  10. 10.
    Senior, K. (2000). Testing the ICIDH-2 with indigenous Australians: Results of field work in two aboriginal communities in the northern territory., AIHW, ICIDH Collaborating Centre, and Department of Health and Family Services, Editors. Canberra.Google Scholar
  11. 11.
    Al Sayah, F., et al. (2013). Health related quality of life measures in Arabic speaking populations: A systematic review on cross-cultural adaptation and measurement properties. Quality of Life Research, 22(1), 213–229.CrossRefPubMedGoogle Scholar
  12. 12.
    Alghadeer, A., Newton, T., & Dunne, S. (2010). Cross cultural adaptation of oral health-related quality of life measures. Dental Update, 37(10), 706.PubMedGoogle Scholar
  13. 13.
    Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of Clinical Epidemiology, 46(12), 1417–1432.CrossRefPubMedGoogle Scholar
  14. 14.
    Serhier, Z., et al. (2012). Cross-cultural adaptation and validation of the knee and hip health-related quality of life (OAKHQoL) in a Moroccan Arabic-speaking population. Rheumatology International, 32(4), 1015–1023.CrossRefPubMedGoogle Scholar
  15. 15.
    Chow, M. Y. K., et al. (2013). Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: A systematic review. Quality of Life Research, 22(8), 2183–2200.CrossRefPubMedGoogle Scholar
  16. 16.
    Jardine, J., et al. (2014). Self-reported quality of life of young children with conditions from early infancy: A systematic review. Pediatrics, 134(4), e1129–e1148.CrossRefPubMedGoogle Scholar
  17. 17.
    Stevens, K., & Ratcliffe, J. (2012). Measuring and valuing health benefits for economic evaluation in adolescence: An assessment of the practicality and validity of the child health utility 9D in the Australian adolescent population. Value in Health, 15(8), 1092.Google Scholar
  18. 18.
    Bakas, T., et al. (2012). Systematic review of health-related quality of life models. Health and Quality of Life Outcomes, 10, 134.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Angell, B. J., et al. (2014). Global systematic review of the cost-effectiveness of indigenous health interventions. PLoS One, 9(11), e111249.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Allan, C. L., Flett, B., & Dean, H. J. (2008). Quality of life in first nation youth with type 2 diabetes. Maternal and Child Health Journal, 12(Suppl1), S103–S109.CrossRefGoogle Scholar
  21. 21.
    Barton, S. S., et al. (2005). Health and quality of life of aboriginal residential school survivors, bella Coola valley, 2001. Social Indicators Research, 73(2), 295–312.CrossRefGoogle Scholar
  22. 22.
    Beals, J., et al. (2006). Different factor loadings for SF36: the strong heart study and the national survey of functional health status. Journal of Clinical Epidemiology, 59(2), 208–215.CrossRefPubMedGoogle Scholar
  23. 23.
    Braun, P., et al. (2014). Caregiver reported oral health-related quality of life in young American Indian children. Journal of Immigrant and Minority Health, 16(5), 951–958.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Broughton, J. R., et al. (2012). Self-reported oral health and dental service-use of rangatahi within the rohe of Tainui. New Zealand Dental Journal, 108(3), 90–94.PubMedGoogle Scholar
  25. 25.
    Burhansstipanov, L., et al. (2012). Comparison of quality of life between native and non-native cancer survivors: Native and non-native cancer survivors’ QOL. Journal of Cancer Education, 27(1 Suppl), S106–S113.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Chenhall, R., & Senior, K. (2012). Treating indigenous Australians with alcohol/drug problems: Assessing quality of life. Alcoholism Treatment Quarterly, 30(2), 130–145.CrossRefGoogle Scholar
  27. 27.
    Chenhall, R. D., et al. (2010). Individual quality of life among at risk indigenous youth in Australia. Applied Research in Quality of Life, 5(3), 171–183.CrossRefGoogle Scholar
  28. 28.
    Chowdhury, P. P., Balluz, L., & Strine, T. W. (2008). Health-related quality of life among minority populations in the United States, BRFSS 2001–2002. Ethnicity and Disease, 18(4), 483–487.PubMedGoogle Scholar
  29. 29.
    Daubs, M. D., et al. (2014). Scoliosis research society-22 results in 3052 healthy adolescents aged 10 to 19 years. Spine, 39(10), 826–832.CrossRefPubMedGoogle Scholar
  30. 30.
    Divaris, K., et al. (2011). The relationship of oral health literacy with oral health-related quality of life in a multi-racial sample of low-income female caregivers. Health and Quality of Life Outcomes, 9, 108.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Dyall, L., et al. (2014). Cultural and social factors and quality of life of Maori in advanced age. Te puawaitanga o nga tapuwae kia ora tonu: Life and living in advanced age: A cohort study in New Zealand (LiLACS NZ). New Zealand Medical Journal, 127(1393), 62–79.PubMedGoogle Scholar
  32. 32.
    Dyrbye, L. N., et al. (2007). Race, ethnicity, and medical student well-being in the United States. Archives of Internal Medicine, 167(19), 2103–2109.CrossRefPubMedGoogle Scholar
  33. 33.
    Edwards, S. L., et al. (2012). Construct validity of the SF-12 among American Indian and Alaska Native people using two known scoring methods. Journal of Health Care for the Poor and Underserved, 23(3), 1123–1136.CrossRefPubMedGoogle Scholar
  34. 34.
    Gupchup, G., et al. (2001). Developing a community-specific health-related quality of life (HRQOL) questionnaire for asthma: The asthma-specific quality of life questionnaire for native American adults (AQLQ-NAA). Journal of Asthma, 38(2), 169–178.CrossRefPubMedGoogle Scholar
  35. 35.
    Harwood, M., et al. (2012). An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with Maori and Pacific people following stroke. New Zealand Medical Journal, 125(1364), 57–67.PubMedGoogle Scholar
  36. 36.
    Henderson, J. A., Buchwald, D., & Manson, S. M. (2006). Relationship of medication use to health-related quality of life among a group of older American Indians. Journal of Applied Gerontology, 25(1, Suppl), 89S–104S.CrossRefGoogle Scholar
  37. 37.
    Holtz, C., et al. (2014). A quantitative study of factors influencing quality of life in rural Mexican women diagnosed with HIV. JANAC: Journal of the Association of Nurses in AIDS Care, 25(6), 555–567.PubMedGoogle Scholar
  38. 38.
    Jiang, L., et al. (2009). Health-related quality of life and help seeking among American Indians with diabetes and hypertension. Quality of Life Research, 18(6), 709–718.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Johnson, J. A., Nowatzki, T. E., & Coons, S. J. (1996). Health-related quality of life of diabetic Pima Indians. Medical Care, 34(2), 97–102.CrossRefPubMedGoogle Scholar
  40. 40.
    Kaholokula, J. K., et al. (2006). Ethnic differences in the relationship between depressive symptoms and health-related quality of life in people with type 2 diabetes. Ethnicity and Health, 11(1), 59–80.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Kant, S., et al. (2013). Social, cultural, and land use determinants of the health and well-being of Aboriginal peoples of Canada: A path analysis. Journal of Public Health Policy, 34(3), 461–476.CrossRefGoogle Scholar
  42. 42.
    Kit, J. A., et al. (2003). Chronic disease self-management in Aboriginal communities: Towards a sustainable program of care in rural communities. Australian Journal of Primary Health, 9(2–3), 168–176.CrossRefGoogle Scholar
  43. 43.
    Lix, L. M., Metge, C., & Leslie, W. D. (2009). Measurement equivalence of osteoporosis-specific and general quality-of-life instruments in aboriginal and non-aboriginal women. Quality of Life Research, 18(5), 619–627.CrossRefPubMedGoogle Scholar
  44. 44.
    Lopes, A. A., et al. (2003). Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: The dialysis outcomes and practice patterns study (DOPPS). American Journal of Kidney Diseases, 41(3), 605–615.CrossRefPubMedGoogle Scholar
  45. 45.
    Martin, L. J., et al. (2013). Poorer physical health-related quality of life among aboriginals and injection drug users treated with highly active antiretroviral therapy. Canadian Journal of Public Health, 104(1), e33–e38.Google Scholar
  46. 46.
    McClure, T. M., et al. (2009). The effect of visual impairment on vision-related quality of life in American Indian/Alaska Natives. Ophthalmic Epidemiology, 16(2), 128–135.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    McClure, T. M., et al. (2011). The impact of eyeglasses on vision-related quality of life in American Indian/Alaska natives. American Journal of Ophthalmology., 151(1), 175–182.e2.CrossRefPubMedGoogle Scholar
  48. 48.
    McFall, S. L., Solomon, T. G., & Smith, D. W. (2000). Health-related quality of life of older native American primary care patients. Research on Aging, 22(6), 692–714.CrossRefGoogle Scholar
  49. 49.
    Naughton, M. J., et al. (2008). Health-related quality of life of children and adolescents with type 1 or type 2 diabetes mellitus: SEARCH for diabetes in youth study. Archives of Pediatrics and Adolescent Medicine, 162(7), 649–657.CrossRefPubMedGoogle Scholar
  50. 50.
    Perkins, M., Devlin, N., & Hansen, P. (2004). The validity and reliability of EQ-5D health state valuations in a survey of Maori. Quality of Life Research, 13(1), 271–274.CrossRefPubMedGoogle Scholar
  51. 51.
    Poole, J. L., et al. (2007). Quality of life in American Indian and White women with and without rheumatoid arthritis. The American Journal of Occupational Therapy, 61(3), 280–289.CrossRefPubMedGoogle Scholar
  52. 52.
    Poole, J. L., et al. (2010). Quality of life in American Indian women with arthritis or diabetes. American Journal of Occupational Therapy, 64(3), 496–505.CrossRefPubMedGoogle Scholar
  53. 53.
    Scott, K. M., et al. (2000). A challenge to the cross-cultural validity of the SF-36 health survey: Factor structure in Maori, Pacific and New Zealand European ethnic groups. Social Science and Medicine, 51(11), 1655–1664.CrossRefPubMedGoogle Scholar
  54. 54.
    Spencer, S., et al. (2013). Influence of caregiving on health-related quality of life among American Indians. Journal of the American Geriatrics Society, 61(9), 1615–1620.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Syed Alwi, S. A. R., et al. (2009). The menopausal experience among indigenous women of Sarawak, Malaysia. Climacteric, 12(6), 548–556.CrossRefPubMedGoogle Scholar
  56. 56.
    Thommasen, H. V., et al. (2005). Understanding relationships between diabetes mellitus and health-related quality of life in a rural community. Rural and Remote Health, 5(3), 441.PubMedGoogle Scholar
  57. 57.
    Traebert, J., et al. (2010). Differential item functioning related to ethnicity in an oral health-related quality of life measure. International Journal of Paediatric Dentistry, 20(6), 435–441.CrossRefPubMedGoogle Scholar
  58. 58.
    Ukra, A., et al. (2013). Impact of malocclusion on quality of life among New Zealand adolescents. The New Zealand Dental Journal, 109(1), 18–23.PubMedGoogle Scholar
  59. 59.
    Wells, P. L., et al. (2010). An oral health survey of the Lumbee tribe in southeastern North Carolina. Journal of Dental Hygiene: JDH/American Dental Hygienists’ Association, 84(3), 137–144.Google Scholar
  60. 60.
    Williams, S. D., Parker, E. D., & Jamieson, L. M. (2010). Oral health-related quality of life among rural-dwelling indigenous Australians. Australian Dental Journal, 55(2), 170–176.CrossRefPubMedGoogle Scholar
  61. 61.
    Devlin, N., Hansen, P., & Herbison, P. (2000). Variations in self-reported health status: Results from a New Zealand survey. The New Zealand Medical Journal, 113(1123), 517.PubMedGoogle Scholar
  62. 62.
    Ware, J. E., & Kosinski, M. (2001). Interpreting SF-36 summary health measures: A response. Quality of Life Research, 10(5), 405–413.CrossRefPubMedGoogle Scholar
  63. 63.
    Ware, J. E., & Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology, 51(11), 903–912.CrossRefPubMedGoogle Scholar
  64. 64.
    Gao, Y., et al. (2014). A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the top end of the Northern Territory, Australia. Midwifery, 30(4), 447.CrossRefPubMedGoogle Scholar
  65. 65.
    Jan, S., et al. (2004). An holistic economic evaluation of an aboriginal community-controlled midwifery programme in Western Sydney. Journal of Health Services Research and Policy, 9(1), 14–21.CrossRefPubMedGoogle Scholar
  66. 66.
    Brazier, J., McCabe, C., & Edlin, R. (2004). Health economics and cost consequences analysis: A step back in time. BMJ, 329, 1233.CrossRefGoogle Scholar
  67. 67.
    Cantril, H. (1965). Patterns of human concerns. New Brunswick: Rutgers University Press.Google Scholar
  68. 68.
    Ferrell, B. R., Grant, M. M., Funk, B., OtisGreen, S., & Garcia, N. (1997). Quality of life in breast cancer survivors as identified by focus groups. Psychooncology, 6(1), 13–23.CrossRefPubMedGoogle Scholar
  69. 69.
    Huntington NL, et al. (2011). Development and validation of a measure of pediatric oral health-related quality of life: The POQL. Journal of Public Health Dentistry 71(3), 185–193.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Blake Angell
    • 1
    • 2
    Email author
  • Janani Muhunthan
    • 1
    • 3
  • Anne-Marie Eades
    • 1
  • Joan Cunningham
    • 4
  • Gail Garvey
    • 4
  • Alan Cass
    • 4
  • Kirsten Howard
    • 5
  • Julie Ratcliffe
    • 6
  • Sandra Eades
    • 5
    • 7
  • Stephen Jan
    • 1
    • 2
    • 3
  1. 1.The George Institute for Global Health, Sydney Medical School, The University of SydneySydneyAustralia
  2. 2.The Poche Centre for Indigenous Health, Sydney Medical School, The University of SydneySydneyAustralia
  3. 3.The Australian Prevention Partnership CentreSydneyAustralia
  4. 4.Menzies School of Health Research, Charles Darwin UniversityDarwinAustralia
  5. 5.School of Public HealthUniversity of SydneySydneyAustralia
  6. 6.Flinders Health Economics Group, School of MedicineFlinders UniversityAdelaideAustralia
  7. 7.Aboriginal Health and Disadvantaged Communities Baker IDI Heart and Diabetes InstituteSydneyAustralia

Personalised recommendations